About the speaker: Keith Holland qualified as an Optometrist in 1979, and spent the first part of his career working with Professor Charles Bedwell - one of the early pioneers of children's vision assessment. After being awarded Fellowship of The College of Optometrist in Vision Development in 1999, and was made the first ever life member of The British Association of Behavioural Optometrists in recognition of his contributions to eye care in 2001. Keith lectures internationally on eye care topics, and has published numerous articles in both the professional and popular press as well as appearing on both national and local TV and radio.
Further information about this Talk
Keith Holland's Website
The British Association of Behavioural Optometrists
College of Optometrist Division Development
Key Points Covered in This Talk:
- We take it for granted that children can see easily and we do very little to look into the visual impact on learning. Most people do learn to see well and easily and use their visual system efficiently to learn but some don't. The problem is that it is hard to see when there is a problem. There is no national screening system for eyes in the UK anymore. If eyes are tested on a screening basis the vision problems that can effect learning are often not looked at.
- What are the skills needed for Learning:
- Can you see properly for reading and writing?
- Do your eyes work together?
- Do they work together effortlessly without hurting?
- The Impact of Short Sightedness on Learning: Slightly blurred vision at distance is not too big an issue for learning. Therefore while short sightedness can cause problems for sport and maybe with confidence for playing games, it's not really an issue so far as reading and writing are concerned.
- The Impact of Long Sightedness on Learning: If a child is long sighted that may well cause them problems with fatigue and irritability without effecting their ability to see clearly at far. Most standards tests of distance vision are not related to the issues with reading and writing. Blurred vision at near is much more serious.
- Typically a young child will become very reluctant to engage in reading and writing tasks at near.
- They'll lose concentration, they may be verbally fine and talk well but not really engage in reading and writing.
- Typically they will not be asked to spend long periods engaged in reading or writing until they are about eight or nine so issues may not show up particularly well at an early stage.
- When writing they may use shorter sentences and simpler language in order to minimise what's being asked of them.
Even a small amount of blurred vision at near or transient vision (which is coming and going) is going to have a much bigger impact on reading and writing skills than distance blurred vision. This is not normally looked at in routine eye tests. Always remember that children cannot borrow your eyes to see how you see. It is amazing how often children will sit in a consulting room and when you show them something going fuzzy they say that that happens all the time. They have never said anything because they have never been asked.
- Both Eyes Working Together: Both eyes have to work together on a sustained, accurate basis if we're going to engage in reading and writing. Problems with what we call convergence or the teaming of the two eyes are associated with about one third of all problems with reading and writing. Dealing with them will often increase reading levels significantly and in a short space of time. If the two eyes do not work together text can starts to swim, wobble and dance about as the child looks at it. Some children describe this as fuzziness, some as blurring, some as swimming. All of them will avoid looking at it. Children probably won't say anything if the two eyes are not working together. They'll assume they see in the way that your or I see, therefore they must be stupid or thick in order not to be able to understand it. If they do say anything they'll report swimming, wobbling, fuzzy text, smudgy text, or use language like that. Children under the age of seven will rarely report symptoms. It's usually the older children who become aware that this is perhaps not normal and are able to verbalise it. The young children will just struggle. In the classroom issues with convergence will cause fatigue, eyestrain, and very often cause headaches (typically across the front / brow area). You will often find the child will take abnormal postures: they will tilt over to one side when they're working so that effectively they can switch off using one eye and rely on the other eye. They will associate reading with discomfort and you wlll find a significant percentage of children (often boys) simply just say that they don't do reading.
- Scanning and Tracking Text: The eyes have to scan and track around the page of text and move as we're reading. They have to do that in a controlled way. We use what is called the saccadic eye movement system for this which is the eyes moving in a series of small jumps along the page going from word to word or syllable to syllable or even jumping over several words at a time if a child has good word recognition skills. When that breaks down the child is likely to lose their place and lose their line and become confused and their comprehension will drop. Children will have to go backwards over text, re-reading and have lower comprehension.
- The impact of visual problems on handwriting: Vision problems can have an impact on handwriting, making the task more stressful and uncomfortable and effecting posture. Again this leads to a reluctance to write. Visual help can lead to a great increase in the quantity of writing and in the quality of writing. Often when there are convergence and focus problems the hand eye coordination system breaks down and causes the writing to deteriorate.
- The impact of visual problems on Maths: Maths is a visual task because in many respects it is a shorthand for visual descriptions of space, time, volume, length, height, breadth etc. So a child with a visual problem may well not have good visualisation and the ability to think in those spatial terms needed for maths. They may be able to number crunch and learn to do a rote task with numbers but with little understanding of what they're doing. But graphical work, geometry and trigonometry may cause real difficulties.
- What can we do to help children with visual problems? The first thing is to identify the child with problems. As a parent there are a range of checklists available which you can fill in and complete and score your child to see if there's a likelihood of there being a vision problem (please see the pdf below). Having identified that you then need to seek specialist help. A routine eye test is not likely to pick up some of the more subtle visual issues and you do need to seek out a specialist assessment with an optometrist who has a specialist interest in this field. The British Association of Behavioural Optometrists in the UK maintain a register of optometrists qualified in this field. In the United States and Europe the College of Optometrist Division Development maintain a similar register. There is also more information available on Keith Holland's practice website.